1993, 04-02 Permit App: 93003067 Mechanical Fixtures • MECHANICAL. PERMIT APPLICATION FORM 14,
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.1nforination Worksheet
JOB STREET ADDRESS: (fUlla
CITY/STATE/ZIP: 9c):. /f PARCEL NUMBER: J �a �3 -0 0¢�;
OWNER: 3c�/c RI( 'J ( PHONE NUMBER:.k -
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: I\"OU CO / Cif' V- LICENSE NUMBER: 0DIZC LNFt 17O C.
PHONE NUMBER: 5 3 L( (49745-
-MAILING ADDRESS: E . _h/(`_)• I kuut 99a/A
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
Wt?ODSTOVE/INSEHT .. x 25.00 =
GAS WATER HEATER x 10.00 = --/O.ej
GAS EQUIPMENT X100,000 BTU (INCLUDES x 12.00 = /)) CP;
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
GAS PIPING( A OUTL v N x 1.00 = ,(10
BOILER/REFRIG 1-100M BTU x 12.00 =
BOILEAIREFRIG 101-500M'BTU : x 20.00 =
BOILER/REFRIG 501-1,000M BTU x 25.00 =
BOII ER REFI IG 1 0001. 1 750M:BTU x 35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
HAAT PUMP &'AIA CONDITIONER 0-3 TONS : .. x 12.00 =
HEAT PUMP &AIR CONDITIONER 3-15 TONS x 20.00 =
HEAT PUMP a AIR CONDITI� N R 15 30 TONS x 25.00 =
HEAT PUMP &AIR CONDITIONER 30-50 TONS x 35.00 =
HEAT PUMP &AIR CONDITIONER +50 TONS x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE;COOLERS x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
TYPE II HOOD x 10.00 =
CLOTHES DRYER x 10.00 =
RANGE x 10.00 =
GAS LOG x 10.00 =
MISCEl I ANEOUS (SOT COVERED ELSEWH i E x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
U,LINSTED GAS APPLIANCE>QQ4 OU0 BTU x100.00 =
USED APPLIANCE<400,000 BTU x 50.00 =
USED APPLIANCE>400,000 BTU x100.00
AIR HANDLER <10,000 CFM x 12.00 =
AIR HANDLER>10,0Q0 CFM x 15.00 =
SUBTOTAL $ LID
PLUS: PROCESSING FEE + $ 25.00
NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT
FEE DUE = $ ,
0 SIGNATURE
Spokane County Division of Buildings Lf Q )-
W6gt 1300 Broadway Avenue Spokane. WA 9921i0 (50c1 4SR-:4F75